Daniel Halliday
Apr 5 · Last update 1 mo. ago.

What can we learn about COVID-19 from the flu pandemic of 1918?

Despite being colloquially referred to as the Spanish Flu there is limited evidence surrounding the origin of the 1918 H1N1 influenza pandemic. But this pandemic is has become one of the major points of comparison to COVID-19 due to the rapid spread, and being a novel form of a viral infection that had effected the world many times before. Despite a large technological jump between 1918 and the modern day many parallels can be drawn and many issues that faced societies in 1918 have not yet been overcome. What lessons can we draw from history in the handling of pandemics, how can we stop history repeating, and why is COVID-19 so heavily paralleled against the 1918 flu pandemic?
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Need to strengthen healthcare
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Misdiagnosis
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We need to be mindful of the second wave
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Mask wearing curbed the spread
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International travel was a major driver
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Overcrowding can be a major driver
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Lessons already learned – a better understanding of the risks
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Not comparable different virus and different time
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Misinformation
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Need to strengthen healthcare

During 1918 the influenza pandemic known as Spanish flu overwhelmed hospitals worldwide, and there was a need for many more trained healthcare professionals, and lacking the time to train physicians registered nurses flocked into the healthcare sector to fill the gap. In this way the 1918 Spanish flu changed the nursing profession, stepping up the number and importance of nurses in a healthcare setting. But it revolutionised healthcare systems and the government's role in fighting health issues also. The COVID-19 pandemic spells out the need to improve healthcare infrastructure globally, as even international disasters require prepared and equipped community responses, on a local level, around the world.

Respect for healthcare professionals and the status of nurses has arguably only improved in modern times, evident from the numerous large public displays of support for healthcare workers around the world. But this call to radically change healthcare needs heeding again, just as nurses expanded the response to the overwhelming number of sick people in 1918, we now need strengthen our public health networks that have been cut or underfunded for decades. Until this kind of public healthcare network can be safely relied on we run the risk of further susceptibility to disease pandemics in the future.

inquirer.com/philly/health/5-questions-how-the-1918-spanish-flu-pandemic-changed-the-nursing-profession-20181109.html smithsonianmag.com/history/how-1918-flu-pandemic-revolutionized-public-health-180965025 foxnews.com/us/tribute-essential-health-care-workers-across-america bbc.com/news/av/uk-52319191/coronavirus-uk-residents-clap-for-our-carers inquirer.com/philly/health/5-questions-how-the-1918-spanish-flu-pandemic-changed-the-nursing-profession-20181109.html

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Daniel Halliday
Apr 26
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DH edited this paragraph
During 1918 the influenza pandemic known as Spanish flu overwhelmed hospitals worldwide, and there was a need for many more trained healthcare professionals, and lacking the time to train physicians registered nurses flocked into the healthcare sector to fill the gap. In this way the 1918 Spanish flu changed the nursing profession, stepping up the number and importance of nurses in a healthcare setting. But it revolutionised healthcare systems and the government's role in fighting health issues also. The COVID-19 pandemic spells out the need to improve healthcare infrastructure globally, as even international disasters require prepared and equipped community responses, on a local level, around the world.

Misdiagnosis

Misdiagnosis was rife in 1918, as in addition to the on going First World War, symptoms were also unusual and variable in many people infected with H1N1 making diagnosis difficult, as a result many were diagnosed with other infections such as Cholera, Typhoid or Dengue Fever. In addition to fever there was a widespread issue of haemorrhaging, with many of those effected globally bleeding from the nose, stomach, the intestines, and even from the ears and the skin in some cases. A similar problem remains over a century later, and is complicated further by a lack of healthcare infrastructure globally making testing and diagnosis even more difficult.

Although comparatively less gruesome, the SARS-CoV-2 has caused a range of reactions also, from severe pneumonia, fever, coughing, sneezing, and even more unusual symptoms such as a loss of smell and taste, and even purple legions on the toes. This is in addition to a currently unknown incubation period and a seemingly high number of asymptomatic carriers of the virus making the medical picture COVID-19 paints a distinctly difficult one to try and slow the spread of. But as testing is not being carried out in some countries, and very few are actually carrying out the World Health Organisation’s advice on testing, the widespread failure to diagnose is leaving many countries in the dark as to how widespread the virus actually is, potentially making under-diagnosis a similar complication with COVID-19.

ncbi.nlm.nih.gov/books/NBK22148 usatoday.com/story/news/health/2020/03/24/coronavirus-symptoms-loss-smell-taste/2897385001 politico.com/news/2020/03/06/coronavirus-testing-failure-123166 techcrunch.com/2020/03/16/who-calls-for-rapid-escalation-in-global-covid-19-response-including-testing-and-isolation today.com/health/skin-symptoms-related-coronavirus-doctors-discuss-covid-toes-t178991

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Daniel Halliday
Apr 26
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DH edited this paragraph
Although comparatively less gruesome, the SARS-CoV-2 has caused a range of reactions also, from severe pneumonia, fever, coughing, sneezing, and even more unusual symptoms such as a loss of smell and taste, and even purple legions on the toes. This is in addition to a currently unknown incubation period and a seemingly high number of asymptomatic carriers of the virus making the medical picture COVID-19 paints a distinctly difficult one to try and slow the spread of. But as testing is not being carried out in some countries, and very few are actually carrying out the World Health Organisation’s advice on testing, the widespread failure to diagnose is leaving many countries in the dark as to how widespread the virus actually is, potentially making under-diagnosis a similar complication with COVID-19.

We need to be mindful of the second wave

As troops were confined to the trenches of the First World War the H1N1 influenza virus spread like wildfire. But it was random mutation of a more fatal strain of the virus that led to troops being sent away from the trenches to field hospitals, and it was there that the deadly second wave of the virus began, as this aggressive strain quickly spread around the world. A 2007 study published in the Journal of the American Medical Association, found that in 1918, as the pandemic appeared to subside the city of St. Louis, Missouri ended social isolation measures just to find fatalities sharply increased. This needs to be a lesson to modern societies, as many countries now see new infections falling the memory of this second wave of the 1918 pandemic needs to be kept in mind, countries need to be slow to break social isolation practices and vigilant when returning to normality.

history.com/news/spanish-flu-second-wave-resurgence chicagotribune.com/coronavirus/ct-nw-nyt-coronavirus-flu-collide-fall-20200423-xff4mmewqvfc5jnoglsopr2dba-story.html vox.com/policy-and-politics/2020/3/24/21188121/coronavirus-covid-19-social-distancing-1918-spanish-flu

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Daniel Halliday
Apr 23
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DH edited this paragraph
https://www.history.com/news/spanish-flu-second-wave-resurgence https://www.chicagotribune.com/coronavirus/ct-nw-nyt-coronavirus-flu-collide-fall-20200423-xff4mmewqvfc5jnoglsopr2dba-story.html https://www.vox.com/policy-and-politics/2020/3/24/21188121/coronavirus-covid-19-social-distancing-1918-spanish-flu

Mask wearing curbed the spread

There are many lessons to take from the 1918 pandemic, but at a most basic level we can see that early preventative measures that are adhered to and become ingrained truly do save lives, and in 1918 mask wearing was one of these measures. States such as San Francisco actually passed a law making it illegal to not wear a mask in public, those caught without one faced fines or even imprisonment. Today the message from the United States’ Centers for Disease Control and Prevention (CDC) and Surgeon General are much less clear, as advice on mask wearing has been contradictory. While this may be an attempt to curb the public buying important medical supplies more than an accurate claim against the efficacy of masks, masks do seem to be useful, a 2011 study from the National Institutes of Health found that mask wearing, along with multiple sustained social containment measures, helped San Francisco in taming the spread of influenza.

edition.cnn.com/2020/04/03/americas/flu-america-1918-masks-intl-hnk/index.html vox.com/policy-and-politics/2020/3/24/21188121/coronavirus-covid-19-social-distancing-1918-spanish-flu blog.genealogybank.com/the-history-of-the-great-1918-flu-pandemic-we-all-wore-masks.html time.com/5794729/coronavirus-face-masks

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Daniel Halliday
Apr 23
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International travel was a major driver

Clearly COVID-19 reached pandemic proportions due to modern society’s growing appetite for international travel. But this was also the case in 1918, with the spread of H1N1 influenza being so wide due to the troops being shipped across the world to fight the First World War, influenza and pneumonia affected up to 40% of the US Army and Navy officers in late 1918. But international travel has become more and more of a normality in the last 100 years, and now represents a major industry with some region’s economies dependent on international tourism. Coming out of this pandemic a clear pattern is emerging, and we need to consider if this growing habit is worth it, if so greater health check measures may become a permanent part of airport security checks in the future.

ncbi.nlm.nih.gov/pmc/articles/PMC2862337 thoughtco.com/1918-spanish-flu-pandemic-1779224 thepointsguy.com/news/flying-after-coronavirus-health-screenings-in-airports-and-emptier-planes

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Daniel Halliday
Apr 23
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Overcrowding can be a major driver

There were two distinct waves during the 1918 pandemic, the second being much more deadly than the first. Striking in the autumn of 1918, the second wave of the pandemic was worsened by the First World War, and specifically by a viral mutation exacerbated by the conditions in the trenches. The virus spread rapidly in overcrowded field hospitals and then quickly back to civilian populations as the virus spread around the world for a second, much deadlier, outbreak. We can see this is still an issue a century later, with overcrowded cities such as New York having a markedly worse reaction to COVID-19, the link between growing urbanisation and emerging infectious disease needs to be considered in future pandemic mitigation.

webcitation.org/5gcuRTA6L?url=http://www.parliament.the-stationery-office.com/pa/ld200506/ldselect/ldsctech/88/88.pdf newyorker.com/magazine/1997/09/29/the-dead-zone ncbi.nlm.nih.gov/pmc/articles/PMC4481042

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Daniel Halliday
Apr 23
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Lessons already learned – a better understanding of the risks

The 1918 flu pandemic was thought to be so deadly due to the tendency of the causative strain of influenza to produce a “cytokine storm”, an overreaction of the body’s own immune response, in reaction to the virus. Similar conditions have also been noted of the COVID-19 pandemic, and excessive cytokine release is thought to be behind the quick decline seen in many fatalities seen in COVID-19 patients. However thanks to modern medicine we now have low risk methods of dealing with such deteriorations, and there are numerous therapies that may aid this most dangerous reaction to the virus. Antihistamines, commonly used for allergies, have been shown to reduce the severity of cytokine storms, as has melatonin a harmless hormone that the body naturally released as part of the human sleep cycle, and curcumin a yellow chemical contained in ginger and turmeric.

ncbi.nlm.nih.gov/pmc/articles/PMC340389 ncbi.nlm.nih.gov/pubmed/25600522 survivalblog.com/letter-elderberry-wuhan

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Daniel Halliday
Apr 23
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Not comparable different virus and different time

While many are drawing comparisons between the COVID-19 pandemic and the last known global pandemic of history, the Spanish flu, beyond being a pandemic the viral outbreaks are actually very dissimilar and comparisons may not be helpful. The 1918 influenza pandemic was unusual in the fact that it caused a lot of death in young adults whereas COVID-19 mainly threatens the lives of the elderly and immune impaired. That is not to mention the countless technological and healthcare advances that have been made during the 20th century; meaning healthcare is unrecognisably more advanced in the present day. In this way the SARS-CoV-2 virus that causes COVID-19 is unlikely to actually reach the same level of a pandemic as the Spanish flu, with its death toll of 50 million, making the virus and the period to different to compare.

nytimes.com/2020/03/09/health/coronavirus-is-very-different-from-the-spanish-flu-of-1918-heres-how.html

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Daniel Halliday
Apr 23
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Misinformation

Science was by no means as developed as the present day during the Spanish Flu pandemic, and misinformation about the causes and solutions to influenza greatly worsened the death toll, but it was government censorship that proved most devastating. America became the heart of the global pandemic in 1918 also, as the government suppressed the outbreak with the Congress the Sedition Act, fearing news of the pandemic would be detrimental to the war effort they banned leaders and the press from mentioning the flu. Ignorance of the outbreak meant that in a short space of time cities suddenly faced tens of thousands dead, as the death toll rose to 700,000 Americans and 100 million people globally, mostly during the last six months of 1918. This level of censorship would be much harder today to accomplish today in light of the Internet and social media, but while censorship may be less of an issue misinformation is much more prevalent online, and could potentially lead to people breaking government guidelines or trying to cure themselves with reckless remedies.

baltimoresun.com/maryland/carroll/lifestyles/cc-lt-dayhoff-032220-20200320-wmahqlv3drbghpv2hziglq4jny-story.html msn.com/en-us/news/technology/lessons-of-the-spanish-flu-misinformation-leads-to-disaster-worse-than-war/ar-BB11OuAX history.com/news/spanish-flu-deaths-october-1918 who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters cbsnews.com/news/coronavirus-news-arizona-man-dies-after-taking-chloroquine-drug-touted-by-trump-as-treatment

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Daniel Halliday
Apr 13
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